ACR is providing additional guidance on key measure changes affecting radiology practices that plan to report incidental finding measures for the 2017 Merit-based Incentive Program System (MIPS) program. Coding staff and clinical leaders must be certain they are reporting quality measures using the latest specifications guidance provided by the Centers for Medicare and Medicaid Services (CMS).
The 2017 measure guidance includes separate reporting instructions for claims and registry reporting mechanisms. The numerator quality data coding options have been updated for measures #405 and #406. Highlighted below are a few significant changes:
| Quality ID # | Title | Description | Code Changes/Notes |
| 405 | Appropriate Follow-up Imaging for Incidental Abdominal Lesions |
Percentage of final reports for abdominal imaging studies for asymptomatic patients aged 18 years and older with one or more of the following noted incidentally with follow‐up imaging recommended:
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ACR Guidance for Reporting #405
If reporting this measure via claims, select the appropriate codes for reporting:
- To be in compliance with the measure, report G9550 and G9547 (Performance Not Met) - this is an inverse measure, therefore, a lower calculated performance rate indicates better clinical care.
- G9551 (Denominator Exclusion) should be reported if the final radiology report for abdominal
imaging studies does not have an incidentally found lesion noted. - G9547 and G9549 (Denominator Exception) should be reported if there is a documented medical reason indicating follow-up imaging is recommended
- G9548 and G9547 (Performance Met) should be reported when final reports include incidental findings and with follow-up imaging recommended
If reporting this measure via registry, select the appropriate codes for reporting:
- G9547 (incidental finding noted in report) is included as a denominator code. Report only these cases to the registry.
- To be in compliance with the measure report G9550 (Performance Not Met) - this is an inverse measure, therefore, a lower calculated performance rate indicates better clinical care.
- G9549 (Denominator Exception) should be reported if there is a documented medical reason indicating follow-up imaging is recommended.
- G9548 should be reported for final reports with follow-up imaging recommended
| Quality ID # | Title | Description | Code Changes/Notes |
| 406 | Appropriate Follow-up Imaging for Incidental Thyroid Nodules in Patients |
Percentage of final reports for computed tomography (CT), CT angiography (CTA) or magnetic resonance imaging (MRI) or magnetic resonance angiogram (MRA) studies of the chest or neck or ultrasound of the neck for patients aged 18 years and older with no known thyroid disease with a thyroid nodule < 1.0 cm noted incidentally with follow-up imaging recommended |
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ACR Guidance for Reporting #406
If reporting this measure via claims, select the appropriate codes for reporting:
- To be in compliance with the measure, report G9556 and G9552 (Performance Not Met) - this is an inverse measure, therefore, a lower calculated performance rate indicates better clinical care.
- G9557 (Denominator Exclusion) should be reported if the final radiology report does not have an incidentally found thyroid nodule <1.0 cm noted or no nodule found.
- G9552 and G9555 (Denominator Exception) should be reported if there is a documented medical reason indicating follow-up imaging is recommended and incidental thyroid nodule <1.0 cm is noted in report.
- G9552 and G9554 should be reported when final reports include incidental thyroid nodule < 1.0 cm noted and with follow-up imaging recommended.
If reporting this measure via registry, select the appropriate codes for reporting:
- G9552 (incidental thyroid nodule < 1.0 cm noted in report) is included as a denominator code. Report only these cases to the registry.
- To be in compliant with the measure, report G9556 (Performance Not Met) - this is an inverse measure, therefore, a lower calculated performance rate indicates better clinical care.
- G9555 (Denominator Exception) should be reported if there is a documented medical reason indicating follow-up imaging is recommended
- G9554 (Performance Met) should be reported for final reports with follow-up imaging recommended.
Note
Denominator exceptions are conditions that should remove a patient, procedure or unit of measurement from the denominator of the performance rate only if the numerator criteria are not met. It allows for clinical judgement. Denominator exclusions refer to patients with conditions who should be removed from the measure population and denominator before determining if numerator criteria are met.
For measure code changes on all quality measures relevant to radiologists, reference the measures tables below that contain instructions for reporting MIPS measures by specialty area.
- Diagnostic radiology
- Interventional radiology
- Nuclear medicine
- Radiation oncology
For more information, visit www.acr.org/qpp.